A new peer-reviewed study published in JAMA Pediatrics has found that neonatal mortality—the death of an infant within the first 28 days of life— fell by 50% following the launch of Rx Kids, while early neonatal mortality—the death of an infant within the first 7 days of life—fell by 74%.
The findings represent a remarkable reduction in a longstanding disparity between Flint and the rest of Michigan and provide new evidence that community-wide financial support during pregnancy and infancy can improve the survival of infants at a population level.
“This is the outcome that matters most, our babies surviving,” said Dr. Mona Hanna, director of Rx Kids and associate dean for public health at Michigan State University College of Human Medicine. “As a pediatrician, I have cared for families through the unimaginable loss of a newborn. These early findings are deeply encouraging and suggest that supporting families during pregnancy and infancy, with money as medicine, may be one of our most powerful prescriptions for saving babies’ lives.”
Researchers analyzed statewide birth and death records from 2021 through 2025, comparing Flint with the rest of Michigan. Before Rx Kids launched, Flint’s neonatal mortality rate was more than twice that of the rest of the state, at 10.2 versus 4.0 deaths per 1,000 live births.
In 2025, one year after the launch of Rx Kids in Flint, the neonatal mortality rate fell by 50%, to 5.1 deaths per 1,000 live births, while the rest of Michigan remained virtually unchanged at 3.9.
The decline was even greater during the first week of life, with early neonatal mortality falling by 74%, from 7.9 to 2.0 deaths per 1,000 live births.
These improvements dramatically narrowed a longstanding disparity in newborn survival. For the first time during the study period, differences in neonatal and early neonatal mortality between Flint and the rest of Michigan were no longer statistically significant.
The findings build on earlier peer-reviewed research published in The Lancet Public Health, which found that following the launch of Rx Kids, Flint experienced an estimated 18% reduction in preterm births, a 27% reduction in low birth weight, and a 29% reduction in neonatal intensive care unit admissions.
Preterm birth and low birth weight are leading contributors to newborn mortality, making the new survival findings consistent with previously documented improvements in birth outcomes.
“Being born too soon or too small can mean the difference between life and death in a baby’s first month,” said Dr. Sumit Agarwal, a physician and health economist at the University of Michigan, assistant professor at the U-M Medical School and School of Public Health, and a faculty affiliate of Poverty Solutions at U-M. “The reduction in neonatal mortality seen in Flint is exactly what we would expect after improving rates of healthy births. When we invest in families during pregnancy and infancy, more babies are born healthy and more babies make it through those critical first weeks of life.”
Rx Kids is the nation's first community-wide maternal and infant cash prescription program, providing $1,500 during pregnancy and $500 per month during infancy to families in participating communities. The program addresses the economic insecurity that often accompanies pregnancy and childbirth, a critical window for lifelong health and development.
“Many partners have been diligently working to lower Michigan’s infant mortality rates and allow babies to survive and thrive in our state”, said Amy Zaagman, Executive Director, Michigan Council for Maternal and Child Health. “The data shows adding Rx Kids has had a profound impact on reducing the rates of early infant loss in Flint. As we advocate to maintain the systems and supports families need, we know Rx Kids and its direct support to families is an essential part of improving maternal and infant health outcomes in other communities and statewide.”
There are multiple pathways through which greater economic security may contribute to healthier pregnancies, healthier births, and improved infant survival. Previous Rx Kids research has shown improvements in housing stability, food hardship, maternal mental health, child welfare involvement prevention, as well as an increase in prenatal care utilization and trust in healthcare institutions. Additionally, Rx Kids families frequently report using funds to purchase baby supplies, including cribs and bassinets, which may support safer sleep environments for babies which prevents infant deaths.
Researchers will continue examining infant and maternal mortality as additional years of data become available and in more Rx Kids communities. Future studies will investigate whether these improvements are sustained and replicated across different populations and settings, and explore the mechanisms connecting financial support to maternal and infant survival.
Since launching in Michigan in January 2024, Rx Kids has expanded to more than 60 communities nationally, served more than 18,000 families, and generated a growing body of rigorous and peer-reviewed evidence demonstrating the health, economic, and community impacts of universal and unconditional cash transfers for moms and babies.
Rx Kids is a national maternal and infant health program led by Michigan State University and administered by GiveDirectly in partnership with local Community Champions. Learn more at RxKids.org
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About Rx Kids
Rx Kids is the nation’s first-ever, community-wide maternal and infant cash prescription program, founded and directed by Dr. Mona Hanna, pediatrician and Associate Dean of Public Health at Michigan State University College of Human Medicine. Administered by GiveDirectly, the global leader in cash transfers, Rx Kids has efficiently delivered direct support to thousands of families across dozens of communities—strengthening family financial security, improving maternal and infant health, and boosting local economies.
Rx Kids is built on a strong network of partners who bring together academic leadership, community expertise, and public–private investment to make this vision possible. Co-founded by Michigan State University and Poverty Solutions at the University of Michigan, Rx Kids is implemented in partnership with local Community Champions and stakeholders who drive outreach, engagement, and celebration. Sustained through a robust public–private partnership that blends state investment with philanthropic and other support, Rx Kids reimagines what’s possible with a prescription for health, hope, and opportunity.
Journal
JAMA Pediatrics